Provider Demographics
NPI:1174594642
Name:BOWDEN, ROY THOMAS III (DO)
Entity type:Individual
Prefix:
First Name:ROY
Middle Name:THOMAS
Last Name:BOWDEN
Suffix:III
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3701 MACCORKLE AVE SE
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25304-1525
Mailing Address - Country:US
Mailing Address - Phone:304-720-2345
Mailing Address - Fax:
Practice Address - Street 1:3701 MACCORKLE AVE SE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304-1525
Practice Address - Country:US
Practice Address - Phone:304-720-2345
Practice Address - Fax:304-720-2347
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1668207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV5600478000Medicaid
WV0878453Medicare ID - Type Unspecified
WV5600478000Medicaid
WV0878455Medicare PIN